What are the treatment options for Temporomandibular Joint (TMJ) disorders?

From the Guidelines

Temporomandibular joint (TMJ) disorder treatment should typically begin with conservative approaches, prioritizing cognitive behavioural therapy (CBT), therapist-assisted mobilisation, and supervised jaw exercise and stretching, as recommended by the most recent guideline 1. The treatment of TMJ disorders involves a range of options, from conservative management to more invasive procedures.

• Conservative approaches include:
  • Over-the-counter pain relievers like ibuprofen (400-600mg every 6-8 hours) or naproxen (220-440mg twice daily) to reduce inflammation and pain 1
  • Moist heat or ice packs applied to the jaw for 10-15 minutes several times daily to relieve discomfort
  • Soft diet modifications, such as avoiding hard, chewy foods and cutting food into smaller pieces
  • Gentle jaw stretching exercises performed 3-4 times daily to improve mobility
  • Custom-fitted night guards from a dentist to prevent teeth grinding and clenching during sleep
  • Stress management techniques, such as meditation or deep breathing, to help reduce muscle tension
• More invasive options, such as surgery, should only be considered if conservative measures do not provide relief after 2-3 weeks, and under the guidance of a healthcare provider 1. It is essential to note that the most recent guideline recommends against irreversible oral splints, discectomy, and NSAIDs with opioids due to the potential for adverse effects and lack of evidence supporting their effectiveness 1. Overall, the primary goal of TMJ disorder treatment is to decrease pain and functional limitation, improve quality of life, and encourage self-management through education, as improved self-efficacy leads to fewer symptoms 1.

From the Research

Treatment Options for Temporomandibular Joint (TMJ) Disorders

The treatment options for TMJ disorders can be categorized into conservative and surgical approaches.

• Conservative therapies include:
  • Noninvasive pharmacologic therapies, such as nonsteroidal anti-inflammatory drugs, muscle relaxants, benzodiazepines, antidepressants, and anticonvulsants 2
  • Physical therapy modalities, such as iontophoresis and phonophoresis 3
  • Psychological therapies, such as cognitive behavior therapy 3
  • Relaxation techniques and complementary therapies, such as acupuncture and hypnosis 3
  • Therapeutic exercises, including stretching, relaxation, coordination, strengthening, and endurance 4
  • Massage therapy, manual therapy, and taping 5
• Minimally invasive treatments include:
  • Muscular and articular injections, such as botulinum toxin, corticosteroids, platelet-rich plasma, hyaluronic acid, and prolotherapy with hypertonic glucose 2
  • Occlusal splint therapy 3, 5
• Surgical options are considered for severe cases of TMJ degeneration, including surgical restoration of the joint 5

Pharmacologic Treatment

Pharmacologic treatment options are available for the management of TMJ disorders, including mild to moderate cases 2. These options can be used in conjunction with other conservative therapies to improve symptoms of pain and function of the TMJ.

Multidisciplinary Approach

A multidisciplinary team approach to management is essential in the fundamental care of all TMD patients, allowing treatment to be specifically tailored to individual patient needs 6. This approach may involve collaboration between oral and maxillofacial surgeons, physical therapists, psychologists, and other healthcare professionals.